Objective To investigate the correlation between platelet-to-albumin ratio(PAR)and occurrence of cerebral infarction after left atrial appendage closure(LAAC)in patients with non-valvular atrial fibrillation(NVAF).Methods A retrospective study was conducted on 259 NVAF patients undergoing LAAC in our department between 2019 and 2023.According to occurrence of cerebral infarction after LAAC or not,they were divided into a control group(241 cases)and a study group(18 cases).Their general data were collected,and Cox proportional hazards regression model was used to identify the risk factors for cerebral infarction.ROC curve was plotted to assess the predictive value of PAR for cerebral infarction in NVAF patients after LAAC,and the AUC value was calculated.Kaplan-Meier survival curve was drawn to analyze the incidence of cerebral infarction after LAAC in NVAF patients with different PAR values.Results The study group had significantly advanced age,higher SBP at admission,increased WBC,neutrophil,monocyte and platelet counts,longer thrombin time,elevated international normalized ratio(INR)and high-sensitivity C-reactive protein(hs-CRP)level,and higher PAR than the control group(P＜0.05,P＜0.01).Multivariate Cox regression analysis showed that PAR(HR=2.286,95％CI:1.182-4.420,P＜0.05)was an independent risk factor for cerebral infarction in NVAF patients after LAAC.ROC curve indicated that the AUC value of PAR in predicting cerebral infarction after LAAC in NVAF patients was 0.721(95％CI:0.586-0.856,P＜0.01),with an optimal cut-off value of 4.137,a sensitivity of 66.39％,and a specificity of 77.78％.Kaplan-Meier survival curve revealed that the higher the PAR value was,the higher the risk of cerebral infarction was(P＜0.01).Conclusion PAR is significantly correlated with cerebral infarction in NVAF patients after LAAC.The higher the PAR,the higher the risk of cerebral infarction,demonstrating its predictive value and being worthy of clinical promotion.

Objective To investigate the correlation between platelet-to-albumin ratio(PAR)and occurrence of cerebral infarction after left atrial appendage closure(LAAC)in patients with non-valvular atrial fibrillation(NVAF).Methods A retrospective study was conducted on 259 NVAF patients undergoing LAAC in our department between 2019 and 2023.According to occurrence of cerebral infarction after LAAC or not,they were divided into a control group(241 cases)and a study group(18 cases).Their general data were collected,and Cox proportional hazards regression model was used to identify the risk factors for cerebral infarction.ROC curve was plotted to assess the predictive value of PAR for cerebral infarction in NVAF patients after LAAC,and the AUC value was calculated.Kaplan-Meier survival curve was drawn to analyze the incidence of cerebral infarction after LAAC in NVAF patients with different PAR values.Results The study group had significantly advanced age,higher SBP at admission,increased WBC,neutrophil,monocyte and platelet counts,longer thrombin time,elevated international normalized ratio(INR)and high-sensitivity C-reactive protein(hs-CRP)level,and higher PAR than the control group(P＜0.05,P＜0.01).Multivariate Cox regression analysis showed that PAR(HR=2.286,95％CI:1.182-4.420,P＜0.05)was an independent risk factor for cerebral infarction in NVAF patients after LAAC.ROC curve indicated that the AUC value of PAR in predicting cerebral infarction after LAAC in NVAF patients was 0.721(95％CI:0.586-0.856,P＜0.01),with an optimal cut-off value of 4.137,a sensitivity of 66.39％,and a specificity of 77.78％.Kaplan-Meier survival curve revealed that the higher the PAR value was,the higher the risk of cerebral infarction was(P＜0.01).Conclusion PAR is significantly correlated with cerebral infarction in NVAF patients after LAAC.The higher the PAR,the higher the risk of cerebral infarction,demonstrating its predictive value and being worthy of clinical promotion.

Background and aims:Kehuang(KH)capsule is an herbal medical product approved for the treatment of liver diseases,including liver injury,in China.However,the mechanism is still unclear.This study aimed to elucidate the protective effects of KH capsule against carbon tetrachloride(CCl4)-induced acute liver injury(ALI)in a murine model.Methods:Mice were randomly divided into control,model(CCl4),CCl4+KH_Low and CCl4+KH_High group.Liver enzyme levels and histological changes were assessed to evaluate liver injury.Oxidative stress markers and inflammatory cell infiltration in liver tissues were measured.Additionally,network pharmacology was employed to explore the potential mechanisms of KH capsule.Results:KH capsule significantly reduced serum alanine aminotransferase(ALT)and aspartate amino-transferase(AST)levels,as well as the necrotic area in liver tissue.KH capsule also decreased the infil-tration of macrophages and neutrophils,thereby inhibiting the expression of interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α),and interleukin-1 beta(IL-1β).Furthermore,KH capsule decreased liver malondialdehyde(MDA)levels and increased superoxide dismutase(SOD)activity.The number of ter-minal deoxynucleotidyl transferase(TdT)-mediated dUTP nick-end labeling(TUNEL)-positive cells in liver tissue was also reduced.The expression of nuclear factor erythroid 2 related factor 2(Nrf2)and heme oxygenase-1(HO-1)proteins was significantly elevated,while the protein expression of cyto-chrome P450 2E1(CYP2E1)was significantly reduced.Mass spectrometry identified genistein,galangin,wogonin,skullcapflavone Ⅱ,and hispidulin as potential active ingredients of KH capsule.Network pharmacology analysis revealed enrichment in the mitogen-activated protein kinase(MAPK)and phosphatidylinositol 3-kinase(PI3K)-protein kinase B(AKT)signaling pathways.Western blot analysis confirmed that KH capsule suppressed AKT,extracellular signal-regulated kinase(ERK),and p38 signaling.Conclusions:These findings suggest that KH capsule could exert protective effects against CCl4-induced ALI,with the inhibition of MAPK and PI3K-AKT signaling pathways playing a crucial role in its mecha-nism of action.

Psychiatric symptoms caused by COVID-19 (SARS-CoV-2) infection are common in clinical practice. In addition to the anxiety, depression, and insomnia, which are often seen, COVID-19 infection also leads to new onset of psychotic symptoms or exacerbation of pre-existing psychiatric symptoms. This study reported a case of a patient with a history of bipolar disorder who presented with clinical manifestations of catatonia after COVID-19 infection. Neurological impairments in this patient were confirmed by neurological physical examination, brain imaging, and cerebrospinal fluid examination. After treatment with lorazepam, glucocorticoids, and low-dose antipsychotics, the patient′s catatonia was significantly relieved. Clinicians should pay attention to the neurological damage caused by COVID-19 infection to be providing comprehensive analysis, diagnosis, and integrated treatment for patients who develop psychiatric symptoms after COVID-19 infection.

Psychiatric symptoms caused by COVID-19 (SARS-CoV-2) infection are common in clinical practice. In addition to the anxiety, depression, and insomnia, which are often seen, COVID-19 infection also leads to new onset of psychotic symptoms or exacerbation of pre-existing psychiatric symptoms. This study reported a case of a patient with a history of bipolar disorder who presented with clinical manifestations of catatonia after COVID-19 infection. Neurological impairments in this patient were confirmed by neurological physical examination, brain imaging, and cerebrospinal fluid examination. After treatment with lorazepam, glucocorticoids, and low-dose antipsychotics, the patient′s catatonia was significantly relieved. Clinicians should pay attention to the neurological damage caused by COVID-19 infection to be providing comprehensive analysis, diagnosis, and integrated treatment for patients who develop psychiatric symptoms after COVID-19 infection.

Objective:To explore the application effect of case-based learning (CBL), teaching mode combined with 3D printing in clinical teaching of sacral tumors.Methods:A total of 108 undergraduate interns and standardized residency training students who studied in our hospital from 2017 to 2018 were divided into the CBL teaching group ( n = 53) and the CBL combined with 3D printing teaching group ( n = 55) according to their study time. The combined teaching group used computer tomography (CT) data to reconstruct and print out a 3D model of sacral tumors based on CBL, and performed preoperative teaching on the invasion of the surrounding tissues of the tumor. The scores of the students in the two groups were evaluated respectively, and the students were surveyed by self-identification questionnaire (learning interest, self-learning ability, teamwork ability, comprehensive analysis ability and clinical thinking ability). The t-test (one-sided) was used for comparison between groups using stata 14.0. Results:The score of CBL teaching group (75.90±6.70) was lower than that of CBL combined with 3D printing teaching group (83.60±7.40). In terms of critical thinking ability evaluation, self-learning ability, learning interest, comprehensive analysis ability and clinical thinking ability, the CBL combined 3D printing teaching group was superior to the CBL teaching group, and the difference was statistically significant ( P<0.001). In terms of teamwork ability, there was no statistical difference between the two groups. Conclusion:The CBL teaching mode combined with 3D printing can improve academic performance, students' learning interest and clinical thinking ability of sacral tumors in the teaching of undergraduate interns and standardized residency training students.